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1.
Rev. SPAGESP ; 21(2): 41-54, jul.-dez. 2020.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1125730

RESUMO

A teoria do estresse de minoria (EM) defende que minorias sociais vivenciam estressores específicos adicionais aos estressores cotidianos. Fatores individuais e do meio podem funcionar como fatores de risco e/ou de proteção no comprometimento da saúde mental de pessoas LGB. O objetivo deste estudo é apresentar e discutir a teoria do EM em indivíduos LGB por meio de uma revisão narrativa. Compreender a ocorrência do EM em pessoas LGB pode auxiliar na elaboração de planos interventivos, de ordem clínica ou social, com o objetivo de minimizar os efeitos do preconceito nestes indivíduos.


The minority stress (MS) theory argues that social minorities experience specific stressors added to everyday stressors. Individual and contextual factors can function as risk and/or protective factors without compromising the mental health of LGB people. This study aims to present and discuss the theory of MS in LGB individuals through a narrative review. Understanding the occurrence of MS in LGB people can assist in the elaboration of intervention plans, of a clinical or social nature to minimize the effects of prejudice in these situations.


La teoría del estrés de minoría (EM) argumenta que las minorías sociales experimentan factores estresantes que se agregan a los factores estresantes cotidianos. Los factores individuales y contextuales pueden funcionar como factores de riesgo o protectores sin comprometer la salud mental de las personas LGB. El objetivo de este estudio es presentar y discutir la teoría de EM en individuos LGB a través de una revisión narrativa. Comprender el EM en personas LGB puede ayudar en la elaboración de planes de intervención, de naturaleza clínica o social, con el objetivo de minimizar los efectos de los prejuicios en estas situaciones.


Assuntos
Preconceito , Estresse Psicológico , Saúde Mental , Risco , Vulnerabilidade Social , Narração , Compreensão , Fatores de Proteção , Minorias Sexuais e de Gênero , Angústia Psicológica , Grupos Minoritários
4.
Int J Equity Health ; 19(1): 189, 2020 10 27.
Artigo em Inglês | MEDLINE | ID: mdl-33109197

RESUMO

There has been mounting evidence of the disproportionate involvement of black, Asian and minority ethnic (BAME) communities by the Covid-19 pandemic. In the UK, this racial disparity was brought to the fore by the fact that the first 11 doctors to die in the UK from Covid-19 were of BAME background. The mortality rate from Covid-19 among people of black African descent in English hospitals has been shown to be 3.5 times higher when compared to rates among white British people. A Public Health England report revealed that Covid-19 was more likely to be diagnosed among black ethnic groups compared to white ethnic groups with the highest mortality occurring among BAME persons and persons living in the more deprived areas. People of BAME background account for 4.5% of the English population and make up 21% of the National Health Service (NHS) workforce. The UK poverty rate among BAME populations is twice as high as for white groups. Also, people of BAME backgrounds are more likely to be engaged in frontline roles. The disproportionate involvement of BAME communities by Covid-19 in the UK illuminates perennial inequalities within the society and reaffirms the strong association between ethnicity, race, socio-economic status and health outcomes. Potential reasons for the observed differences include the overrepresentation of BAME persons in frontline roles, unequal distribution of socio-economic resources, disproportionate risks to BAME staff within the NHS workspace and high ethnic predisposition to certain diseases which have been linked to poorer outcomes with Covid-19. The ethnoracialised differences in health outcomes from Covid-19 in the UK require urgent remedial measures. We provide intersectional approaches to tackle the complex racial disparities which though not entirely new in itself, have been often systematically ignored.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/terapia , Disparidades nos Níveis de Saúde , Grupos Minoritários/estatística & dados numéricos , Pneumonia Viral/etnologia , Pneumonia Viral/terapia , Medicina Estatal/organização & administração , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Humanos , Pandemias , Reino Unido/epidemiologia
5.
Am J Nephrol ; 51(10): 786-796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33011717

RESUMO

BACKGROUND: Although diffuse alveolar damage and respiratory failure are the key features of coronavirus disease 2019 (COVID-19), the involvement of other organs such as the kidney has also been reported. The reports of the incidence of acute kidney injury (AKI) in COVID-19 patients vary widely. In this study, we report our unique experience with AKI in COVID-19 patients in a low socioeconomic and predominantly ethnic minority group and provide its incidence, risk factors, and prognosis to expand the current understanding of this complication. METHODS: In this single-center, retrospective cohort study, we analyzed the data of 469 COVID-19 patients admitted to the Brookdale University Hospital in Brooklyn, NY, from March 18 through April 23, 2020. Information regarding demographics, comorbidities, medications, clinical and laboratory data, and outcomes was collected from the electronic medical records. Both univariate and multivariate analyses were performed to determine the association of AKI with in-hospital mortality. RESULTS: The median age was 66 years (interquartile range [IQR] 25-75; range 19-101 years), and 268 (57.14%) patients were male. Estimated glomerular filtration rate (eGFR) as determined by the Modification of Diet in Renal Disease Study Equation was low (<60 mL/min/1.73 m2) in 207 (44.1%) patients. During hospitalization, 128 (27.3%) patients developed AKI, and the incidence was significantly higher in those patients presenting with a low eGFR (N = 81, 39.1%; p < 0.001). Male sex, hypertension, the use of angiotensin-converting enzyme inhibitors and non-steroidal anti-inflammatories, hemodynamic instability, mechanical ventilation, acute respiratory distress syndrome, and admission elevated ferritin, creatinine kinase, brain natriuretic peptide, and troponin 1 were identified as the risk factors for in-hospital AKI. Ninety-seven (28.45%) patients died in the non-AKI group versus 91 (71.1%) in the AKI group (p < 0.001). The Cox proportional hazard model after adjusting for age, gender, comorbidities, hemodynamic status, and PF ratio (arterial oxygen partial pressure [PaO2]/fractional inspired oxygen [FiO2]) determined that on admission, an elevated blood urea nitrogen (hazard ratio [HR]: 1.75; 95% confidence interval [CI] 1.23-2.48), a low eGFR (HR 1.43; CI 1.1-2.03), AKI stage 1 (HR 1.14; CI 0.64-2.03), AKI stage 2 (HR 1.86; CI 1.03-3.56), and AKI stage 3 (HR 2.1; CI 1.3-2.81) were independent risk factors for in-hospital mortality. Renal replacement therapy (RRT) did not improve survival in stage III AKI. CONCLUSION: AKI in our hospitalized COVID-19 patients was common and carried a high mortality, especially in patients with AKI stage 3. RRT did not improve survival. Policy changes and planning for this high incidence of AKI in COVID-19 patients and its associated high mortality are necessary at the local and national levels.


Assuntos
Lesão Renal Aguda/mortalidade , Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Hospitais Urbanos/organização & administração , Pneumonia Viral/complicações , Políticas , Lesão Renal Aguda/diagnóstico , Lesão Renal Aguda/terapia , Lesão Renal Aguda/virologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Hospitais Urbanos/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Terapia de Substituição Renal/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
6.
PLoS One ; 15(10): e0240960, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33112892

RESUMO

BACKGROUND: Black, Asian and minority ethnic (BAME) populations are emerging as a vulnerable group in the severe acute respiratory syndrome coronavirus disease (SARS-CoV-2) pandemic. We investigated the relationship between ethnicity and health outcomes in SARS-CoV-2. METHODS AND FINDINGS: We conducted a retrospective, observational analysis of SARS-CoV-2 patients across two London teaching hospitals during March 1 -April 30, 2020. Routinely collected clinical data were extracted and analysed for 645 patients who met the study inclusion criteria. Within this hospitalised cohort, the BAME population were younger relative to the white population (61.70 years, 95% CI 59.70-63.73 versus 69.3 years, 95% CI 67.17-71.43, p<0.001). When adjusted for age, sex and comorbidity, ethnicity was not a predictor for ICU admission. The mean age at death was lower in the BAME population compared to the white population (71.44 years, 95% CI 69.90-72.90 versus, 77.40 years, 95% CI 76.1-78.70 respectively, p<0.001). When adjusted for age, sex and comorbidities, Asian patients had higher odds of death (OR 1.99: 95% CI 1.22-3.25, p<0.006). CONCLUSIONS: BAME patients were more likely to be admitted younger, and to die at a younger age with SARS-CoV-2. Within the BAME cohort, Asian patients were more likely to die but despite this, there was no difference in rates of admission to ICU. The reasons for these disparities are not fully understood and need to be addressed. Investigating ethnicity as a clinical risk factor remains a high public health priority. Studies that consider ethnicity as part of the wider socio-cultural determinant of health are urgently needed.


Assuntos
Betacoronavirus , Infecções por Coronavirus/etnologia , Grupos Étnicos/estatística & dados numéricos , Pandemias , Pneumonia Viral/etnologia , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Criança , Pré-Escolar , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Mortalidade Hospitalar , Hospitais de Ensino/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Atenção Secundária à Saúde/etnologia , Atenção Secundária à Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
7.
PLoS One ; 15(10): e0238510, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33035215

RESUMO

We examine how solitary confinement correlates with self-reported adverse physical health outcomes, and how such outcomes extend the understanding of the health disparities associated with incarceration. Using a mixed methods approach, we find that solitary confinement is associated not just with mental, but also with physical health problems. Given the disproportionate use of solitary among incarcerated people of color, these symptoms are most likely to affect those populations. Drawing from a random sample of prisoners (n = 106) in long-term solitary confinement in the Washington State Department of Corrections in 2017, we conducted semi-structured, in-depth interviews; Brief Psychiatric Rating Scale (BPRS) assessments; and systematic reviews of medical and disciplinary files for these subjects. We also conducted a paper survey of the entire long-term solitary confinement population (n = 225 respondents) and analyzed administrative data for the entire population of prisoners in the state in 2017 (n = 17,943). Results reflect qualitative content and descriptive statistical analysis. BPRS scores reflect clinically significant somatic concerns in 15% of sample. Objective specification of medical conditions is generally elusive, but that, itself, is a highly informative finding. Using subjective reports, we specify and analyze a range of physical symptoms experienced in solitary confinement: (1) skin irritations and weight fluctuation associated with the restrictive conditions of solitary confinement; (2) un-treated and mis-treated chronic conditions associated with the restrictive policies of solitary confinement; (3) musculoskeletal pain exacerbated by both restrictive conditions and policies. Administrative data analyses reveal disproportionate rates of racial/ethnic minorities in solitary confinement. This analysis raises the stakes for future studies to evaluate comparative prevalence of objective medical diagnoses and potential causal mechanisms for the physical symptoms specified here, and for understanding differential use of solitary confinement and its medically harmful sequelae.


Assuntos
Avaliação do Impacto na Saúde , Prisioneiros/psicologia , Isolamento Social/psicologia , Adulto , Doença Crônica , Disparidades nos Níveis de Saúde , Humanos , Masculino , Grupos Minoritários , Saúde das Minorias , Dor Musculoesquelética/etiologia , Prisões , Autorrelato , Inquéritos e Questionários , Washington
8.
Am J Respir Crit Care Med ; 202(7): e95-e112, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33000953

RESUMO

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.


Assuntos
Tomada de Decisão Compartilhada , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Neoplasias Pulmonares/diagnóstico , Fumar/etnologia , Definição da Elegibilidade , Grupos Étnicos/estatística & dados numéricos , Custos de Cuidados de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Ciência da Implementação , Cobertura do Seguro , Marketing de Serviços de Saúde/métodos , Medicaid , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Sexuais , Fumar/epidemiologia , Fumar/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Classe Social , Estados Unidos
9.
MMWR Morb Mortal Wkly Rep ; 69(42): 1517-1521, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33090984

RESUMO

During February 12-October 15, 2020, the coronavirus disease 2019 (COVID-19) pandemic resulted in approximately 7,900,000 aggregated reported cases and approximately 216,000 deaths in the United States.* Among COVID-19-associated deaths reported to national case surveillance during February 12-May 18, persons aged ≥65 years and members of racial and ethnic minority groups were disproportionately represented (1). This report describes demographic and geographic trends in COVID-19-associated deaths reported to the National Vital Statistics System† (NVSS) during May 1-August 31, 2020, by 50 states and the District of Columbia. During this period, 114,411 COVID-19-associated deaths were reported. Overall, 78.2% of decedents were aged ≥65 years, and 53.3% were male; 51.3% were non-Hispanic White (White), 24.2% were Hispanic or Latino (Hispanic), and 18.7% were non-Hispanic Black (Black). The number of COVID-19-associated deaths decreased from 37,940 in May to 17,718 in June; subsequently, counts increased to 30,401 in July and declined to 28,352 in August. From May to August, the percentage distribution of COVID-19-associated deaths by U.S. Census region increased from 23.4% to 62.7% in the South and from 10.6% to 21.4% in the West. Over the same period, the percentage distribution of decedents who were Hispanic increased from 16.3% to 26.4%. COVID-19 remains a major public health threat regardless of age or race and ethnicity. Deaths continued to occur disproportionately among older persons and certain racial and ethnic minorities, particularly among Hispanic persons. These results can inform public health messaging and mitigation efforts focused on prevention and early detection of infection among disproportionately affected groups.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/mortalidade , Grupos Étnicos/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Grupos Minoritários/estatística & dados numéricos , Pandemias , Pneumonia Viral/etnologia , Pneumonia Viral/mortalidade , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Estatísticas Vitais , Adulto Jovem
12.
JAMA Netw Open ; 3(10): e2026373, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33119111

RESUMO

Importance: Policy makers have relaxed restrictions for certain nonessential industries, including construction, jeopardizing the effectiveness of social distancing measures and putting already at-risk populations at greater risk of coronavirus disease 2019 (COVID-19) infection. In Texas, Latinx populations are overly represented among construction workers, and thus have elevated rates of exposure that are compounded by prevalent high-risk comorbidities and lack of access to health care. Objective: To assess the association between construction work during the COVID-19 pandemic and hospitalization rates for construction workers and the surrounding community. Design, Setting, and Participants: This decision analytical model used a mathematical model of COVID-19 transmission, stratified by age and risk group, with construction workers modeled explicitly. The model was based on residents of the Austin-Round Rock metropolitan statistical area, with a population of 2.17 million. Based on 500 stochastic simulations for each of 15 scenarios that varied the size of the construction workforce and level of worksite transmission risk, the association between continued construction work and hospitalizations was estimated and then compared with anonymized line-list hospitalization data from central Texas through August 20, 2020. Exposures: Social distancing interventions, size of construction workforce, and level of disease transmission at construction worksites. Main Outcomes and Measures: For each scenario, the total number of COVID-19 hospitalizations and the relative risk of hospitalization among construction workers was projected and then compared with relative risks estimated from reported hospitalization data. Results: Allowing unrestricted construction work was associated with an increase of COVID-19 hospitalization rates through mid-August 2020 from 0.38 per 1000 residents to 1.5 per 1000 residents and from 0.22 per 1000 construction workers to 9.3 per 1000 construction workers. This increased risk was estimated to be offset by safety measures (such as thorough cleaning of equipment between uses, wearing of protective equipment, limits on the number of workers at a worksite, and increased health surveillance) that were associated with a 50% decrease in transmission. The observed relative risk of hospitalization among construction workers compared with other occupational categories among adults aged 18 to 64 years was 4.9 (95% CI, 3.8-6.2). Conclusions and Relevance: The findings of this study suggest that unrestricted work in high-contact industries, such as construction, is associated with a higher level of community transmission, increased risks to at-risk workers, and larger health disparities among members of racial and ethnic minority groups.


Assuntos
Indústria da Construção , Infecções por Coronavirus/etiologia , Hospitalização , Exposição Ocupacional/efeitos adversos , Pandemias , Pneumonia Viral/etiologia , Adolescente , Adulto , Betacoronavirus , Comorbidade , Grupos de Populações Continentais , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/etnologia , Infecções por Coronavirus/virologia , Grupos Étnicos , Feminino , Hispano-Americanos , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários , Pneumonia Viral/epidemiologia , Pneumonia Viral/etnologia , Pneumonia Viral/virologia , Características de Residência , Fatores de Risco , Segurança , Texas/epidemiologia , Local de Trabalho , Adulto Jovem
13.
BMJ Open ; 10(10): e040638, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33067300

RESUMO

OBJECTIVE: To undertake a case review of deaths in a 6-week period during the COVID-19 pandemic commencing with the first death in the hospital from COVID-19 on 12th of March 2020 and contrast this with the same period in 2019. SETTING: A large London teaching hospital. PARTICIPANTS: Three groups were compared: group 1-COVID-19-associated deaths in the 6-week period (n=243), group 2-non-COVID deaths in the same period (n=136) and group 3-all deaths in a comparison period of the same 6 weeks in 2019 (n=194). PRIMARY AND SECONDARY OUTCOME MEASURES: This was a descriptive analysis of death case series review and as such no primary or secondary outcomes were pre-stipulated. RESULTS: Deaths in patients from the Black, Asian and minority ethnic (BAME) communities in the pandemic period significantly increased both in the COVID-19 group (OR=2.43, 95% CI=1.60-3.68, p<0.001) and the non-COVID group (OR=1.76, 95% CI=1.09-2.83, p=0.02) during this time period and the increase was independent of differences in comorbidities, sex, age or deprivation. While the absolute number of deaths increased in 2020 compared with 2019, across all three groups the distribution of deaths by age was very similar. Our analyses confirm major risk factors for COVID-19 mortality including male sex, diabetes, having multiple comorbidities and background from the BAME communities. CONCLUSIONS: There was no evidence of COVID-19 deaths occurring disproportionately in the elderly compared with non-COVID deaths in this period in 2020 and 2019. Deaths in the BAME communities were over-represented in both COVID-19 and non-COVID groups, highlighting the need for detailed research in order to fully understand the influence of ethnicity on susceptibility to illness, mortality and health-seeking behaviour during the pandemic.


Assuntos
Grupo com Ancestrais do Continente Africano , Grupo com Ancestrais do Continente Asiático , Betacoronavirus , Hospitais/estatística & dados numéricos , Grupos Minoritários , Pandemias/ética , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Comorbidade , Infecções por Coronavirus , Feminino , Humanos , Londres/epidemiologia , Masculino , Pneumonia Viral , Estudos Retrospectivos , Taxa de Sobrevida/tendências
14.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(9): 1522-1526, 2020 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-33076611

RESUMO

Objective: To explore the current status of HBV infection before pregnancy among rural childbearing age people in Yunnan province, find out the population at high risk and areas with high incidence and provide evidence for promoting pre-pregnancy aristogenesis and medical interventions for prevention of HBV infection. Methods: The subjects in the study were rural childbearing age people aged 18-49 who received the national free pre pregnancy eugenic health examination in Yunnan province during 2013-2017. Descriptive analysis was conducted for HBsAg positive rate and its difference among various characteristics. The SPSS 22.0 software was used for statistical analysis. Results: A total of 2 180 841 rural childbearing age people were surveyed, the HBsAg positive rate before pregnancy was 3.13%(68 314/2 180 841) in Yunnan. And the HBsAg positive rate was 3.56% (37 694/1 057 376) in men, higher than that in women (2.73%, 30 620/1 123 465). The HBsAg positive rate was highest in age group 41-49 years (3.77%, 3 126/82 931). The HBsAg positive rate was higher in minority ethnic group (3.77%, 27 974/742 518) than in Han ethnicity group (2.81%, 40 024/1 425 870). Moreover, the highest HBsAg positive rate of was 8.20%(851/10 378) in Yao ethnic group. The people with education level of primary education had the highest HBsAg positive rate (3.97%, 17 294/435 219). The HBsAg positive rate was highest in Xishuangbanna Dai autonomous prefecture (6.65%, 3 875/58 232) in Yunnan. Moreover, the HBsAg positive population in severe poor area (3.32%, 19 755/595 665) was higher than those in less poor area (3.17%, 29 750/939 101) or normal areas (2.91%, 18 809/646 075). There was significant difference in HBsAg positive rate among populations in different age groups, ethnic groups, education level groups, areas and economic level groups (P<0.001). Conclusions: The HBsAg positive rate in rural childbearing age people in Yunnan was related to multi factors, including sex, age, ethnic group, education level, area and economic development level. The HBsAg positive rate was higher in men, older age and lower education level, minority ethnic group (especially in Yao ethnic group), from Xishuangbanna prefecture and the poor living conditions in childbearing age population.


Assuntos
Antígenos de Superfície da Hepatite B , Programas de Rastreamento , População Rural , Adolescente , Adulto , China , Grupos Étnicos/estatística & dados numéricos , Feminino , Antígenos de Superfície da Hepatite B/análise , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-33081120

RESUMO

BACKGROUND: Previous studies of minority groups in times of emergency have tended to focus on risk reduction or on individual resilience, overlooking the community factors that could be bolstered to promote better health and safety outcomes. The current study aimed to examine the role of health-care services in the perceived community resilience of urban and suburban Arab communities in Israel during the COVID-19 outbreak. METHOD: The study included 196 adults age 17-76 years, who filled out on-line questionnaires in May 2020; 112 participants lived in an urban community and 84 lived in a suburban community. Community resilience was evaluated using the Conjoint Community Resiliency Assessment Measure (CCRAM), a validated five-factor multidimensional instrument. RESULTS: Residents of the suburban community reported higher community resilience than residents of the urban community. This difference was related to increased preparedness levels and strength of place attachment in the suburban community. Residents of suburban communities were also more satisfied and confident in health-care services than those of urban communities. Regression analysis showed that the satisfaction with primary health-care services, and not community type, significantly predicted community resilience. CONCLUSIONS: Our results support the pivotal role of primary health care in building community resilience of minority communities in times of emergency and routine.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Grupos Minoritários/psicologia , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde , Características de Residência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Humanos , Israel/epidemiologia , Pessoa de Meia-Idade , Grupos Minoritários/estatística & dados numéricos , Pandemias , Satisfação do Paciente , Projetos Piloto , Adulto Jovem
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1376-1379, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018245

RESUMO

In this paper, we present a framework to address the augmentation of images for the rare and minor appearance of mitotic type staining patterns, for Human Epithelium Type2 (HEp-2) cell images. The identification of mitotic patterns among non-mitotic/interphase patterns is important in the process of diagnosis of various autoimmune disorders. This task leads to a pattern classification problem between mitotic v/s interphase. However, among the two classes, typically, the number of mitotic cells are relatively very less. Thus, in this work, we propose to generate synthetic mitotic samples, which can be used to augment the number of mitotic samples and balance the samples of mitotic and interphase patterns in classification paradigm. An effective feature representation is used, to validate the usefulness of the synthetic samples in classification task, along with a subjective validation done by a medical expert. The results demonstrate that the approach of generating and mingling synthetic samples with existing training data works well and yields good performance, with 0.98 balanced class accuracy (BcA) in one case, over a public dataset, i.e., UQ-SNP I3A Task-3 mitotic cell identification dataset.


Assuntos
Doenças Autoimunes , Processamento de Imagem Assistida por Computador , Humanos , Interfase , Grupos Minoritários
17.
RMD Open ; 6(3)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33011680

RESUMO

OBJECTIVE: There is emerging evidence that COVID-19 disproportionately affects people from racial/ethnic minority and low socioeconomic status (SES) groups. Many physicians across the globe are changing practice patterns in response to the COVID-19 pandemic. We sought to examine the practice changes among rheumatologists and what they perceive the impact to be on their most vulnerable patients. METHODS: We administered an online survey to a convenience sample of rheumatologists worldwide during the initial height of the pandemic (between 8 April and 4 May 2020) via social media and group emails. We surveyed rheumatologists about their opinions regarding patients from low SES and racial/ethnic minority groups in the context of the COVID-19 pandemic. Mainly, what their specific concerns were, including the challenges of medication access; and about specific social factors (health literacy, poverty, food insecurity, access to telehealth video) that may be complicating the management of rheumatologic conditions during this time. RESULTS: 548 rheumatologists responded from 64 countries and shared concerns of food insecurity, low health literacy, poverty and factors that preclude social distancing such as working and dense housing conditions among their patients. Although 82% of rheumatologists had switched to telehealth video, 17% of respondents estimated that about a quarter of their patients did not have access to telehealth video, especially those from below the poverty line. The majority of respondents believed these vulnerable patients, from racial/ethnic minorities and from low SES groups, would do worse, in terms of morbidity and mortality, during the pandemic. CONCLUSION: In this sample of rheumatologists from 64 countries, there is a clear shift in practice to telehealth video consultations and widespread concern for socially and economically vulnerable patients with rheumatic disease.


Assuntos
Doenças Autoimunes/etnologia , Betacoronavirus , Grupos de Populações Continentais , Infecções por Coronavirus/epidemiologia , Grupos Étnicos , Grupos Minoritários , Pneumonia Viral/epidemiologia , Pobreza , Doenças Reumáticas/etnologia , Doenças Autoimunes/mortalidade , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Abastecimento de Alimentos/economia , Letramento em Saúde , Habitação , Humanos , Pandemias , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Doenças Reumáticas/mortalidade , Reumatologistas , Inquéritos e Questionários , Telemedicina
19.
Anesth Analg ; 131(4): 1201-1209, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925341

RESUMO

BACKGROUND: The critical question of racial and gender diversity in pediatric anesthesia training programs has not been previously explored. The primary objective of this study was to evaluate trends by race/ethnicity and gender in pediatric anesthesiology fellowship training programs in the United States for the years 2000 to 2018. METHODS: Demographic data on pediatric anesthesiology fellows and anesthesiology residents were obtained from the self-reported data collected for the Journal of the American Medical Association's annual report on Graduate Medical Education for the years 2000 to 2018. Diversity was assessed by calculating the proportions of trainees per year by gender and racial/ethnic groups in pediatric anesthesiology fellowship and anesthesiology residency programs. Logistic regression equations were developed to estimate the annual growth rate of each racial/ethnic groups. RESULTS: The number of pediatric anesthesiology fellows increased from 57 trainees in 2000-2001 to 202 in 2017-2018 at an average rate of 9 fellows per year (95% confidence interval [CI], 8-10). These increases were primarily due to white trainees (54.4%-63.4%) as the proportions of black (7.0%-4.5%), Asian (26.3%-21.3%), and other minority (12.3%-10.9%) trainees have remained low. The number of anesthesiology residents increased from 3950 trainees in 2000-2001 to 5940 in 2017-2018 at an average rate of 99 residents per year (95% CI, 88-111). Within all anesthesiology trainees, these increases were due to white trainees (55.7%-61.3%) as the proportion of black (5.0%-6.0%), Asian (25.8%-24.1%), and other minority trainees (8.2%-8.5%) has remained fairly constant over the time period. Despite the overall lower proportion of female anesthesiology residents (range: 27.0%-37.5%), a steady increase in the number of women in pediatric anesthesiology fellowship programs has reversed the gender imbalance in this population as of 2010. CONCLUSIONS: While historic gains have been made in gender diversity in pediatric anesthesiology, there is persistent underrepresentation of black and Hispanic trainees in pediatric anesthesiology. It appears that their low numbers in anesthesiology residency programs (the reservoir) may be partly responsible. Efforts to increase ethnic/racial diversity in pediatric anesthesiology fellowship and anesthesiology residency training programs are urgently needed.


Assuntos
Anestesiologia/educação , Grupos Étnicos/estatística & dados numéricos , Bolsas de Estudo/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Pediatria/educação , Sexismo/estatística & dados numéricos , Adulto , Afro-Americanos , Americanos Asiáticos , Criança , Estudos de Coortes , Educação de Pós-Graduação em Medicina , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Masculino , Grupos Minoritários , Apoio ao Desenvolvimento de Recursos Humanos , Estados Unidos , Adulto Jovem
20.
J Youth Adolesc ; 49(12): 2409-2428, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32974870

RESUMO

While formal youth mentoring can positively influence youth connectedness, little research has studied the specific approaches mentors engage in that support mentee social development. This study examines how mentors' specific approaches are uniquely associated with youth connection outcomes in formal community-based mentoring. Participants were 766 youth, ranging in age from 11 to 14 (M = 12.29), 56.7% female, and racially/ethnically diverse (41.0% Black/African American, 21.4% Hispanic/Latinx, 20.0% White, 10.2% Multiracial/Multiethnic, 5.9% Native American, 1.2% other race, and 0.4% Asian/Pacific Islander). Person-centered analyses revealed three mentoring profiles which were differentially associated with youth outcomes: "Status Quo Mentors," who reported low-to-moderate levels of closeness within the mentor-mentee dyad, low levels of connecting their mentees with programs and people in their community, and low levels of mediating for their mentees; "Close Connectors," who reported moderate-to-high levels of closeness, moderate-to-high levels of connecting, and low levels of mediating; and "Connector-Mediators," who reported moderate levels of closeness, connecting, and mediating. Youth mentored by "Close Connectors" demonstrated the greatest benefit, with significant improvements in parent-child relationship quality, extracurricular activity involvement, and help-seeking. Results suggest that community-based mentoring programs that emphasize connecting youth within their communities may be more effective in enhancing youth support networks.


Assuntos
Tutoria , Adolescente , Criança , Grupos de Populações Continentais , Feminino , Humanos , Masculino , Mentores , Grupos Minoritários , Mudança Social
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